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Peer-reviewedCC BY 4.0PLOS One

Compensatory proximal malalignment despite preserved macroscopic gait in pediatric flexible flatfoot: A dual-level analysis of static alignment and dynamic kinematics

  • Haojie Wang1
  • Mengxiang Li2
  • Xiaomeng Liang3
  • Weijian Wang
  • Pengren Luo
  • Jiaji Zhang
  • Yuxuan Du
  • Tan Liu
  • Boyu Zhang
  • Xu Wang
  • Zhefeng Jin
  • Yilin Zhu
1 more authors
  • Tao Han
  1. 1The Third Department of Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
  2. 2Rehabilitation Division, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
  3. 3Department of Gynecology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Abstract

Background & objective: Previous biomechanical studies on pediatric flexible flatfoot have treated the subject as a single analytical unit, thus failing to elucidate mechanical transmission within the lower extremity closed kinetic chain. This study investigates the impact of distal arch collapse on macroscopic gait parameters, static joint alignment, and dynamic kinematic deviation by integrating a dual-level analytical strategy at both the subject and individual limb levels. Methods: 153 children with pediatric flexible flatfoot (25 unilateral, 128 bilateral) were included, and 3D gait data from 306 lower extremities were analyzed. At the subject level, macroscopic spatiotemporal parameters were compared using the Mann-Whitney U test. At the limb level, linear mixed-effects models (LMMs) compared static 3D joint angles and Gait Variable Scores (GVS) between normal feet and flatfeet, treating subject as a random effect and adjusting for age, body mass index (BMI), and unilateral leg length. Results: At both the subject and limb levels, no significant between-group differences were observed in any core spatiotemporal parameters (e.g., Mean Velocity, Frequency, and Step Width) (P > 0.05). Regarding static joint alignment at the limb level, the static Hip Rotation angle on the flatfoot side exhibited significantly less external rotation (i.e., relative internal rotation) compared to the normal side (−2.11° ± 0.67° vs. −5.79° ± 1.79°, P = 0.043). During dynamic walking, the Hip Abduction/Adduction GVS on the flatfoot side was significantly elevated (P = 0.032). However, comprehensive gait indices, including the GDI and GPS, showed no significant overall between-group differences. Conclusion: Pediatric flexible flatfoot was associated with subtle proximal biomechanical alterations despite preserved macroscopic gait characteristics. Changes in static hip alignment and dynamic frontal-plane hip kinematics may therefore provide complementary information beyond conventional gait measures, supporting a broader kinetic-chain assessment in clinical evaluation and follow-up.

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Cite

BibTeXRIS
BibTeX
@article{wang2026compensatory,
  title = {{Compensatory proximal malalignment despite preserved macroscopic gait in pediatric flexible flatfoot: A dual-level analysis of static alignment and dynamic kinematics}},
  author = {Haojie Wang and Mengxiang Li and Xiaomeng Liang and Weijian Wang and Pengren Luo and Jiaji Zhang and Yuxuan Du and Tan Liu and Boyu Zhang and Xu Wang and Zhefeng Jin and Yilin Zhu and Tao Han},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0358183},
  url = {https://doi.org/10.1371/journal.pone.0358183},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Compensatory proximal malalignment despite preserved macroscopic gait in pediatric flexible flatfoot: A dual-level analysis of static alignment and dynamic kinematics
AU  - Haojie Wang
AU  - Mengxiang Li
AU  - Xiaomeng Liang
AU  - Weijian Wang
AU  - Pengren Luo
AU  - Jiaji Zhang
AU  - Yuxuan Du
AU  - Tan Liu
AU  - Boyu Zhang
AU  - Xu Wang
AU  - Zhefeng Jin
AU  - Yilin Zhu
AU  - Tao Han
PY  - 2026
DA  - 2026/09/16
JO  - PLOS One
DO  - 10.1371/journal.pone.0358183
UR  - https://doi.org/10.1371/journal.pone.0358183
AB  - Background & objective: Previous biomechanical studies on pediatric flexible flatfoot have treated the subject as a single analytical unit, thus failing to elucidate mechanical transmission within the lower extremity closed kinetic chain. This study investigates the impact of distal arch collapse on macroscopic gait parameters, static joint alignment, and dynamic kinematic deviation by integrating a dual-level analytical strategy at both the subject and individual limb levels. Methods: 153 children with pediatric flexible flatfoot (25 unilateral, 128 bilateral) were included, and 3D gait data from 306 lower extremities were analyzed. At the subject level, macroscopic spatiotemporal parameters were compared using the Mann-Whitney U test. At the limb level, linear mixed-effects models (LMMs) compared static 3D joint angles and Gait Variable Scores (GVS) between normal feet and flatfeet, treating subject as a random effect and adjusting for age, body mass index (BMI), and unilateral leg length. Results: At both the subject and limb levels, no significant between-group differences were observed in any core spatiotemporal parameters (e.g., Mean Velocity, Frequency, and Step Width) (P > 0.05). Regarding static joint alignment at the limb level, the static Hip Rotation angle on the flatfoot side exhibited significantly less external rotation (i.e., relative internal rotation) compared to the normal side (−2.11° ± 0.67° vs. −5.79° ± 1.79°, P = 0.043). During dynamic walking, the Hip Abduction/Adduction GVS on the flatfoot side was significantly elevated (P = 0.032). However, comprehensive gait indices, including the GDI and GPS, showed no significant overall between-group differences. Conclusion: Pediatric flexible flatfoot was associated with subtle proximal biomechanical alterations despite preserved macroscopic gait characteristics. Changes in static hip alignment and dynamic frontal-plane hip kinematics may therefore provide complementary information beyond conventional gait measures, supporting a broader kinetic-chain assessment in clinical evaluation and follow-up.
SN  - 1932-6203
ER  -